IJCS | Volume 31, Nº6, November / December 2018

666 1. Basal M, Kasliwal RR. Echocardiography for left atrial appendage structure and function. Indian Heart J. 2012;64(5):469-75. 2. Dio C. Roman History: books 61-70. Translated by Earnest Cary with Herbert B. Foster. London: Harvard University Press; 1917. (The Loeb Classical Library). 3. Littré ME. Histoire naturelle de Pline, avec la traduction en Français. Tome Second.Paris:L’InstitutdeFrance;1877.(ChezFirmin-Didotetc*,Libraries). 4. MontaigneM. Essais, Tome 2. Chefs d’Oeuvre de la Litterature Française. Paris, Garnier Frères, 1865. v. 14, Chap. 12. 5. Beckert M, Flammang BE, Anderson EJ, Nadler JH. Theoretical and computational fluid dynamics of an attached remora (Echeneis naucrates). Zoology (Jena). 2016;119(5):430-8. 6. Laennec RT. A treatise on the diseases of the chest and on mediate auscultation. 3rd ed. London: Thomas & George Underwood; 1829. 7. Mikell FL, Asinger RW, Elsperger RJ, AndersonWR, HodgesM. Regional stasis of blood in the dysfunctional left ventricle: echocardiographic detection and differentiation from early thrombosis. Circulation. 1982;66(4):755-63. 8. Iliceto S, Antonelli G, SorinoM, Biasco G, Rizon P. Dynamic intracavitary left atrial echoes in mitral stenosis. Am J Cardiol. 1985;55(5):603-6. 9. Fatkin D, Kelly RP, FeneleyMP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-9. 10. Sevimli S, Gundogdu F, Arslan S, Aksakal E, Gurlertop HY, Islamoglu Y, et al. Strain and strain rate imaging in evaluating left atrial appendage function by transesophageal echocardiography. Echocardiography. 2007;24(8):823-9. 11. Uretsky S, Shah A, Bangalore S, Rosenberg L, Sarji R, Cantales DR, et al. Assessment of left atrial appendage function with transthoracic tissue Doppler echocardiography. Eur J Echocardiogr. 2009;10(3):363-71. 12. Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet. 2009;373(9658):155-66. References Charles André Remoras and spontaneous echocardiographic contrast Int J Cardiovasc Sci. 2018;31(6)662-666 Viewpoint This is an open-access article distributed under the terms of the Creative Commons Attribution License blood stasis, increased extracellular matrix turnover, progressive morphological changes and endothelial lesion of the LAA, as well as changes in soluble blood components, such as fibrin D-dimer, and prothrombin fragments. 12 Mechanisms of these processes involve increased activity of the renin-angiotensin system and production of growth factors (especially VEGF), and impaired production of endothelial nitric oxide. Many other factors (age, hypertension, low cardiac index etc.) may additionally increase the risk of thrombogenesis and hence embolism. 12 The word “remora” has been associated for centuries with the slow flow of many fluids, including blood. Intracardiac remora leads to the appearance of SEC in echocardiography and is strongly associated with thrombogenesis and an increased embolic risk. After all, remoras are not responsible for delaying battle ships; however, their connection to cardiology holds strong. Author contributions Conception and design of the research: Andre C. Acquisition of data: Andre C. Analysis and interpretation of the data: Andre C. Writing of the manuscript: Andre C. Critical revision of the manuscript for intellectual content: AndreC. Supervision/as themajor investigador: AndreC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work.